Treatments for stage I esophageal cancer

The following are treatment options for stage I esophageal cancer. Your healthcare team will suggest treatments based on your needs and work with you to develop a treatment plan. They will usually do a nutritional assessment before treatment starts. You may need a stent or feeding tube to make sure you get enough nutrition during treatment.

You may be offered one or more of the following treatments.

Surgery

Surgery is the primary treatment for stage I esophageal tumours that are smaller than 2 cm. For some larger tumours, surgery may be used after neoadjuvant therapyneoadjuvant therapyTreatment given to shrink a tumour before the first-line therapy (the first or standard treatment), which is usually surgery. with chemoradiation.

Esophagectomy is the most common surgery used for stage I esophageal cancer. It removes part or all of the esophagus and nearby lymph nodes. Sometimes part of the stomach is also removed.

Endoscopic treatments

You may be offered endoscopic mucosal resection (EMR) if you have very early esophageal cancer (stage T1a tumour) in the inner layer, or mucosa, of the esophagus.

During EMR, the doctor injects a liquid or uses suction to first lift a tumour away from the submucosa and then removes it. If you have EMR, your healthcare team will do close follow-up to check that the cancer has not come back. They will use an endoscope to check your esophagus every 3 months for the first year, and then once a year after that.

Chemoradiation

Chemoradiation is treatment that combines chemotherapy with radiation therapy. Chemotherapy is given during the same time period as radiation therapy. Some types of chemotherapy make radiation therapy more effective.

If you have a larger tumour, you may be offered chemoradiation before surgery. This is called neoadjuvant chemoradiation.

Chemoradiation may be used as the primary treatment for stage I cancer that is in the part of the esophagus in the neck or in the upper part of the esophagus. It may also be offered as the primary treatment if you are not healthy enough to have, or choose not to have, surgery. If chemoradiation is used as the primary treatment, your healthcare team will do close follow-up by using an endoscope to check that the cancer has not come back.

The most common chemotherapy drugs used in chemoradiation for stage I esophageal cancer are:

carboplatin (Paraplatin, Paraplatin AQ) and paclitaxel (Taxol)

cisplatin (Platinol AQ) and 5-fluorouracil (Adrucil, 5-FU)

cisplatin and capecitabine (Xeloda)

Chemotherapy

You may be offered chemotherapy before and after surgery for adenocarcinoma of the lower esophagus. You may also be offered chemotherapy alone as the primary treatment for stage I esophageal cancer if you are not healthy enough to have, or choose not to have, surgery or chemoradiation.

The most common combinations used in chemotherapy for stage I esophageal cancer are:

ECF – epirubicin (Pharmorubicin), cisplatin and 5-fluorouracil

ECX – epirubicin, cisplatin and capecitabine

epirubicin, oxaliplatin (Eloxatin) and 5-fluorouracil

epirubicin, oxaliplatin and capecitabine

Radiation therapy

You may be offered radiation therapy alone as the primary treatment for stage I esophageal cancer if the tumour is in the upper third of the esophagus. It may also be used as the primary treatment if you are not healthy enough to have, or choose not to have, surgery or chemoradiation.

Clinical trials

You may be asked if you want to join a clinical trial for esophageal cancer. Find out more about clinical trials.